Day 9 Flashcards
What is prehn’s sign?
In testicular torsion the elevation of the testis does not ease pain compared to epididymitis
Most common cause of watery eye in infant
Nasolacrimal duct obstruction
What is wernickes
receptive aphasia, due to a lesion of the superior temporal gyrus, which results in patients being able to produce fluent speech, but comprehension and repetition is impaired.
what causes conduction aphasia
A lesion to the arcuate fasciculus
what causes broca’s
A lesion to the left inferior frontal gyrus
How does serotonin syndrome present?
diaphoresis, tremor, confusion and hyperreflexia
Management of status epilepticus
> ABC
-airway adjunct
-oxygen
-check blood glucose
First-line drugs are benzodiazepines such as diazepam or lorazepam
-in the prehospital setting diazepam may be given rectally
-in hospital IV lorazepam is generally used. This may be repeated once after 10-20 minutes
If ongoing (or ‘established’) status it is appropriate to start a second-line agent such as phenytoin or phenobarbital infusion
If no response (‘refractory status’) within 45 minutes from onset, then the best way to achieve rapid control of seizure activity is induction of general anaesthesia.
where are lesions of HSP normally found?
buttocks, extensor surfaces of legs and arms.
How is dehydration characterised with U&E tests
urea that is proportionally higher than the rise in creatinine
How does fracture of the 5th metatarsal often occur?
forced inversion of the foot and ankle
How does lsd present?
colourful visual hallucinations, depersonalisation , psychosis and paranoia
how is LSD toxicity managed
> Agitation, e.g. from a ‘bad trip’, should be first managed with supportive reassurance in a calm, stress-free environment.
If ineffective, benzodiazepines are the medication of choice.
LSD-induced psychosis may require antipsychotics.
Massive ingestions of LSD should be treated with supportive care, including respiratory support and endotracheal intubation if needed.
Hypertension, tachycardia, and hyperthermia should be treated symptomatically. >Hypotension should be treated initially with fluids and subsequently with vasopressors if required.
Because LSD is rapidly absorbed through the gastrointestinal tract, activated charcoal administration and gastric emptying are of little clinical value by the time a patient presents to the emergency department.
What is beck’s triad
found in cardiac tamponade
Beck’s triad: elevated venous pressure, reduced arterial pressure, reduced heart sounds.
Pulsus paradoxus
May occur with as little as 100ml blood
What is aortic rupture often found?
Deceleration injury
Global t wave inversion in all leads
non-cardiac cause
ECG changes in hypothermia
QT prolongation
What is the marker for carcinoid syndrome?
they release serotonin so urinary 5-HIAA will be high
Cause of croup
parainfluenza virus
risk factors for degenerative cervical myelopathy
> smoking due to its effects on the intervertebral discs
genetics
occupation
investigation for degenerative cervical myelopathy
MRI of cervical spine
showing disc degeneration and ligament hypertrophy, with accompanying cord signal change
What is the M rule
for PBC
: IgM
: anti-mitochondrial antibodies, M2 subtype
: middle aged females
Expected LFTs in hepatocellular disease
ALT: raised 2 fold
ALP: normal
ALT/ALP:5 x
Expected LFTs in cholestatic disease
ALT: normal
ALP: raised 2-fold
ALT/ALP: <2
Expected LFTs in mixed disease
ALT: raised at least 2-fold
ALP: raised 2-fold
ALT/ALP: 2-5
Drugs causing urinary retention
tricyclic antidepressants e.g. amitriptyline anticholinergics opioids NSAIDs disopyramide
DPP4 inhibitors
:increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
:oral preparation
:relatively well tolerated with no increased incidence of hypoglycaemia
:do not cause weight gain
Management of secondary pneumothorax
<1cm, admit and give oxygen for 24 hours and review
what is the only ccb licensed in HF
Amlodipine
most common and important viral infection in solid organ transplant recipients
cytomegalovirus
antibodies in anti-phospholipid
anticardiolipin
patterns of damage of radial nerve
wrist drop
sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals
diagnosis of pertussis
nasal swab
squaring of thumbs
osteoarthritis
management of wells score >2
Doppler proximal leg ultrasound within 4 hours. If a scan cannot be arranged within 4 hours she should be given low-molecular weight heparin to ‘cover her’ until the scan.
presentation of G6PD deficiency
Greek boy develops pallor and jaundice after having a lower respiratory tract infection. He has a history of neonatal jaundice. The blood film shows Heinz bodies
diagnosis of G6PD
enzyme assay around 3 months after acute episode of haemolysis
What is EATL
complication of coeliac disease- enteropathy-associated T cell lymphoma (EATL),
A&E assessment for fluid in abdomen and thorax
FAST scan
